Inspection on 19/08/08 for Chestnut Park Care Home

This inspection was carried out on 19th August 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chestnut Park Care Home 05/05/09

Chestnut Park Care Home 19/01/09

Chestnut Park Care Home 11/12/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOMES FOR OLDER PEOPLE Chestnut Park Care Home Ashwelton House Care Home 15 Magdala Road Mapperley Park Nottingham NG3 5DE Lead Inspector Linda Hirst & Angela Starr Unannounced Inspection 19th August 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut Park Care Home Address Ashwelton House Care Home 15 Magdala Road Mapperley Park Nottingham NG3 5DE 0115 960 8935 0115 960 2791 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Perdeep Ahluwalia Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old Age not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 15 11th December 2007 Date of last inspection Brief Description of the Service: Chestnut Park Care Home provides residential care for up to 15 older people in an adapted property in its own grounds. The home is in Mapperley Park, which is approximately a mile from the centre of Nottingham with its range of shops, places of worship and leisure and recreational facilities. Parking is available on the premises and there is good access to local transport on Mansfield Road. The communal areas consist of a large lounge and a dining room. The bedrooms are on the ground and first floors and there is a vertical lift which gives access to other floors for people who have mobility difficulties. The home has front and rear gardens which can be accessed by ramps. The current fee levels at the home range from £323 to £400 per week depending on care needs. The fees do not include charges for hairdressing and chiropody. The service user guide and the statement of purpose are on display in the reception area of the home and these are given to all prospective residents. A copy of the latest report was not displayed. This is available for people to read at the home if they ask at the office. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. As we did this inspection much earlier than we had planned to because of the information we were receiving which suggested the quality rating may not be right. We did not have time to send out the questionnaire in time for us to use it to plan our inspection and to decide what areas to look at. We have reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called ‘case tracking’ which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. English is the first language of all of the service users living at the home at the moment. The staff team come from a wide variety of backgrounds and experiences. We spoke with members of staff, people who live at the service and relative to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. During the course of our visit we began to find evidence a continued breach of regulations concerning care planning, unsafe recruitment practices and about the safety of the money belonging to people who live at the service. We issued a code B notice under The Police and Criminal Evidence Act 1984 to enable us to take documents from the home with a view to assessing the findings and Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 6 deciding whether to take enforcement action. The Police have been contacted and are undertaking an investigation at the moment. We had to issue two immediate requirements whilst we were at the home about the safety of medicines and the unsafe Moving and Handling we saw. We issue these when we find that the people who live at the service’s health and safety is at risk and where the outcomes for them is poor. We expect the owner to put these matters right within 48 hours and to tell us quickly what they will do, and how they will make sure the people who live at the service are safe and receiving good care. The owners have now asked a manager from a consultancy agency to oversee the service, and the Local Authority have asked Occupational Therapists to go into the home to look at people’s needs and to teach the staff how they should be assisted to move. The Local Authority have also made sure that all of the equipment the home needs to move people in a safe way has been provided. The agency manager has arranged for all prescriptions to be rewritten and all existing supplied of medicines have been returned to the Pharmacist to be destroyed. We have been assured by the staff from the Local Authority who has been visiting the home very regularly that both of these areas of care are now safe. What the service does well: What has improved since the last inspection? Two radiators have had covers fitted to protect people living at the service from the risk of burns and scalds. The providers have also redecorated some parts of the home and fitted new carpets to provide people living there with a comfortable and safe environment to live in. The care plans are now being stored more securely so that people who live at the service know that information about them is stored safely. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 7 What they could do better: We found that the information in the statement of purpose could be better, and people could have ready access to the inspection reports so that they have the information they need to make an informed choice about living at the home. We also found the system in place for assessing people before they come to live at the service could be significantly improved. There are people living at the home whose needs have not been assessed before they were admitted, meaning they cannot be assured these can be met at the service. We also found that when social workers have done assessments of need important information about transmissible infections have not been passed on to staff placing others at risk of cross infection. We found that the acting manager could be clearer about the category of registration for the service and whether the staff are trained to understand specialist needs. She must check out what the person’s primary need for care is to make sure the assessed needs of people can be met and that they are registered to accept them. Every person must have a care plan to tell staff how to help them with their needs and the care plans could be much better, more detailed, updated as needs change and they could offer clearer and more consistent advice to the care staff so they can support people properly. We found the staff were not aware of the correct infection control procedures and that they failed to follow guidance to prevent infections spreading even though they have had training and there is guidance on this in the care plans. We were very concerned about lots of areas to do with people’s health, we found that plans to prevent pressure areas developing were not being followed and this puts people at risk of ill health and discomfort. We also found that the steps to monitor people who are losing weight are still not being followed and this puts their health and wellbeing at risk. The way medication was being handled was dangerous and people were not receiving their medicines as their Doctor prescribed, placing them at significant risk of ill health. We left an immediate requirement about this issue and we understand that a new system has been put in place. The staff do not always respond to the people living at the home in a way which shows respect for them, their dignity and privacy. We feel that they need closer supervision and management to make sure that they are responding to people who live at the service in an appropriate way. There are very few activities at the home and people’s social and recreational needs are not being met. We have serious about the way complaints are being managed. The complaints procedure is not on display in the home so people may not know how to make Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 8 a complaint or the process that will be followed. There is no evidence to show that the complaints which have been recorded have been investigated or that action has been taken to address them. People living at the home cannot be assured that their complaints are taken seriously and acted upon. The staff have not had any training on safeguarding as we required after our last inspection, when we looked at the records of the home and interviewed staff it is clear that they don’t know what types of behaviour are abusive and they have not taken action to report this. The policy at the home on safeguarding does not give staff any guidance and this combination of factors means that people living at the service are vulnerable to abuse. We found that the call alarms are in some cases not sited in easy reach for people living at the service this means they could not summon help easily in an emergency. There are not enough staff on duty to help the people living at the service with all of their needs in a safe and prompt manner, and the rota which shows which staff are on duty does not have enough detail on it to show what hours they have worked. We found that the way staff are recruited to work at the home is not safe; the information and documents to show they are suitable to work with vulnerable people have not been obtained and people living at the service are at risk of people who may harm or abuse them because of this. We will be taking further legal action to get the home to improve their recruitment practices. We could not find a training file or evidence of training for some of the people who are working at the home to help them do their jobs properly. We found that the Moving and Handling practices at the home were very dangerous and exposed people living at the home and staff to the risk of injury. We issued an immediate requirement about this because we were so concerned. Adult Social Care staff made sure that Occupational Therapists went in to train the staff how to move and handle people properly using equipment. We are very concerned following our visit about both the acting manager and the registered providers. There is no registered manager at the service, and we did not find any evidence the service has been managed safely and effectively or that staff have been properly supervised, supported and the quality of their work checked. We found no evidence that the provider has been visiting the home once a month and reporting on how the service is being run and managed. Our evidence shows they have not made sure the service is being run in a safe and effective way with the best interests of the people who are living there in mind. We could find no evidence that Quality Assurance audits have been done to check on the quality of the service being provided, and there is no evidence that the views of people living at the home have been taken into account in the delivery of the service. We have told the proprietors that these areas must improve. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 9 We have serious concerns about the poor systems and record keeping in respect of money which is held on behalf of people living at the service. Their financial interests are not being protected. We found that some of the tests necessary to make sure that electrical equipment and fire safety arrangements are safe have not been done as needed, this places the people living at the service and staff at risk of harm. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who want to live at the service cannot be assured that they have the information they need to make informed decisions. People are being admitted to the service with needs the staff are not trained to understand and support them with. EVIDENCE: We found a copy of the Statement of Purpose on display in the entrance hall of the home. This is not a clear document and does not contain all of the information we would expect to see. We spoke with a relative of a person living at the service who told us, “I was given all of the relevant information.” People told us they had chosen to live at the service as it is near to where relatives live. The files that we looked at did not have any evidence to show that people have been given a service user guide or other information about the home, Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 12 before they moved into the home. We spoke to staff members who told us that they do not always have sufficient information about peoples needs when they are admitted to the service. One staff member told us that they were unaware of a person having a transmissible infection until her son told them. By which time, she had been living at the service for 3 weeks. We case tracked the last person who was admitted to the home, and we looked at the files of three other people living at the service to check their needs have been assessed before they moved into the service. Two of the files we looked at have a copy of the assessment completed by a social worker; the third file did not. We were concerned to hear that staff who work at the home were not made aware that one person has a transmissible infection (which the social worker highlighted on their assessment) for three weeks following admission. During this time no precautions were taken to protect against the spread of infection. This is very poor practice. We also noted that two people have been admitted to the service with needs, which the home is not registered to meet, nor does the statement of purpose cover these needs. This is an offence and failure to comply with the conditions of registration may result in prosecution. The staff we spoke with on the day of the visit told us that they have not had training in Dementia Care and one said, “I help my mum to look after someone with Alzheimer’s so I know what I am doing, I have asked to go on the training” Intermediate care is not provided at the service and the standard is not applicable. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of people living at the service are not being assessed or met. The arrangements for medication are dangerous and place people living at the service at risk of ill health. EVIDENCE: We looked at three care plans to check that they have details of people’s needs which can be used to guide staff in meeting these. We found the care plans to be of poor quality, they were not detailed enough to give clear guidance to staff about how to meet needs. When we observed staff we found they are not following the guidance in the care plan about how needs should be met. (E.g. the care plan for one person with a transmissible infection was not followed and this could result in the infection spreading to other people, another states that only people who have done Moving and Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 14 Handling training should assist the person. Staff who do not have this training were observed assisting in an unsafe manner which could result in injuries to staff and people living at the service.) We found that care plans have not been reviewed for several months and do not reflect the current needs of the people living at the service. (For example we found one person who has been living at the service since May this year who has no care plan in place, and another person needed end of life care and the plan did not reflect this.) Staff we spoke with told us that one person has Speech and Language Therapist support, another person has been referred to a Physiotherapist and said that District Nurses come to the service as needed. That said, a person living at the service told us they always have to ask to be changed. The person’s relative added that it has been requested that Physiotherapy be provided but this has not happened. We have serious concerns from our observations about the provision of health care support at the home in terms of infection control, staff told us that they are unsure whether a person living at the service is now free of infection and do not know how to deliver their care safely. This person was left alone in the lounge to eat their meal. We also witnessed unsafe Moving and Handling practices, a relative told us that staff do not use the hoist that was brought to the home from hospital and that the wheelchair they use has been broken since the person was admitted. (See also OP38.) We found the arrangements in place to prevent pressure area development were inadequate. We looked at the care plan for a person who is at risk of developing pressure areas, the plan indicated they should be turned two hourly at night and changed as soon as required to keep skin healthy. We found a record in a staff complaints book which indicated the person had been left in bed without being turned or changed all night. The person was noted to have developed a pressure area during our visit, but we could find no evidence that this had been referred to the District Nurse. The senior carer did this on our instruction and found the matter had already been referred but not recorded. We also found evidence that two of the people we case tracked were at risk nutritionally; the care plan stated that there would be records of their food intake and records of monthly weights. One weight record was blank and the other had only one entry, there were no records of food intake. We observed that a person who had vomited (part of a specific area of need) but said they felt fine was not offered any lunch. A relative told us that her mother fell and fractured her shoulder, “her shoulder is permanently out,” but added, “the staff know how to look after her.” We did not see evidence that this fall had been recorded, nor did we see a care plan which would tell the staff how to assist the person safely. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 15 We looked at the arrangements for medication and found them to be dangerous. We saw staff give out medicines without checking the Medication Administration Record sheet, tablets had been popped out of blister packs out of the daily sequence making auditing very difficult and we saw medication remained in the blister packs with no record on the Medication Administration Record to indicate the reason for this. Medication needed to prevent strokes and to regulate heartbeats had not been given as prescribed putting people at risk of ill health. When we checked the Medication Administration Record there were multiple gaps evident on every person’s sheet without any explanation for this. One person living at the service told us, “they sometimes forget to put my creams on”. These are creams prescribed by the person’s Doctor and are to be applied twice daily. We found an unlabelled bag of different tablets in the medication trolley and the senior carer could not tell me what tablets they were, for whom they were prescribed and why they were in the bag. We also found medication which had been discontinued still in the trolley when it should have been returned to the Pharmacist. The stocks of medication held at the service seemed unnecessarily high but as there is no record of the stocks of boxed medication being held, auditing the quantities is impossible, leaving a risk of the misappropriation of medication. The policy on medication is very basic and does not follow best practice guidelines provided by the Royal Pharmaceutical Society. We left an immediate requirement about the safety of medication. People living at the service and their relatives expressed satisfaction with the care being provided, telling us, “the staff are very nice,” “my (relative) loves them,” and “I can go on holiday without worrying.” However, some of our observations of the contact between staff and people living at the service concerned us. We saw people being told, rather than asked to do things, when one person said they felt unwell, staff were observed to ignore the person, another person who was asking for help was also ignored and we had to ask staff to assist the person to the toilet. We also saw staff discuss the fact that a person has a transmissible infection in front of other people living at the service, compromising their right to privacy and confidentiality. Given the lack of access to training and supervision it is clear to us that the staff are not being properly guided, monitored and checked. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People who use this service are not able to make choices about their life style. Social, educational, cultural and recreational activities do not meet individual’s expectations. EVIDENCE: We did not observe any activities taking place during our visit, or any evidence that any were planned. We saw people sitting in the lounge without any supervision from staff for a period of 33 minutes, this clearly places people at risk. The television was on but from what we observed no one was watching it, and some people were sitting in parts of the room where they would not have been able to watch television. When a member of staff was in the room, we overheard one person ask if they could go outside, the staff member responded, “I’ll take you when I can, I’m too busy”. The staff we spoke with told us that activities are not recorded and the service does not employ an activities co-ordinator. One relative we spoke with told us that entertainers sometimes visit the home and the staff play games with people who live at the service sometimes. Another told us, “the television is always on but they haven’t been able to watch the Olympics.” Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 17 A person living at the service was celebrating their birthday and the cook had made a cake. We saw several visitors coming in throughout the day and the person’s relative told us that the cook had prepared a meal on their wedding anniversary. We observed people visiting the home throughout the day and all seemed able to talk easily with staff and they were made welcome. We did not see evidence during our visit which would show that people living at the service were helped to exercise choice and control over their lives. One person was told, “we are going to put you in your bedroom.” We observed a person ‘wandering around’ and being told by staff that they had to sit in the lounge. During our visit we observed a number of people requiring assistance from staff and being ignored. One person we spoke with said, “if anyone needs anything, I do it or I shout for someone.” We observed this person attempting to wipe someone’s mouth after they had been sick. During a partial tour of the home we observed that people had personal belongings in their bedrooms. We observed lunch and the people who ate in the dining room were offered a choice. Three people remained in the lounge to eat their meal; one person was not invited to sit in the dining room and the staff seemed confused as to whether the person could eat with other people or not. We observed that the person seemed isolated. We observed another person who is at risk nutritionally refusing lunch, but the staff did not try and encourage or persuade the person to eat. The staff did not record that the person had refused their meal. However, people we spoke with said they are happy with the quality of the food and told us, “the food is good and there is a choice.” A relative told us, “(my relative) is very picky but has eaten well”. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live at the service do not know how to complain, and if they do their concerns are not investigated and responded to appropriately. People who live at the service are at significant risk of harm or abuse. EVIDENCE: We could not find the complaints procedure displayed anywhere in the home, the statement of purpose in the reception area makes reference to there being a formal procedure, but as this is not displayed it would not necessarily result in complaints being made. We looked in the complaints book and found one recorded by a relative concerning the approach and attitude of staff towards them. The senior carer told us that the member of staff in question was spoken with; there is no record of this in the person’s staff file, nor in the complaints record. There is no record of any investigation, and there is no evidence that the complainant has been responded to at all. This is wholly inadequate. One relative told us, “I get very frustrated trying to get things done” There is an outstanding requirement for all staff to have safeguarding training so that they understand what behaviour is abusive and what action to take in Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 19 the event of allegations being made. This has not been done. None of the staff we spoke to have attended safeguarding training and we could not find any evidence of staff training on this subject. We looked at the policy on safeguarding and found it to be wholly inadequate, there is no procedure to be followed in the event of allegations, it offers staff no guidance and makes no reference to the local safeguarding procedures. The copy of local safeguarding procedures at the service is out of date and they do not have a copy of the updated version. These may be obtained online at www.nottsadultprotection.org. The lack of guidance, training, the staff’s poor levels of understanding and failure to follow local safeguarding procedures places people living at the service in a vulnerable position. We found a staff complaints record which indicated that a named person had not been changed through the night, (see OP8) this is neglect but the matter was not referred under safeguarding procedures as it should have been. There is no record of any investigation into this matter. A member of staff told us that the acting manager has spoken to a member of the night staff, there is no record of this and we have not been notified of the issue. During the course of the inspection we found a number of discrepancies in the records held about the finances of people living at the service. We seized records, made a safeguarding referral and contacted the Police to report the matter. This is part of an ongoing Police investigation; we are unable to comment further at this stage. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the service live in a safe, clean and tidy home which meets their needs. EVIDENCE: We did a partial tour of the building and looked at all communal areas; the laundry, kitchen, bathrooms and some bedrooms. We found that there have been a number of improvements since the last inspection including some new carpets in bedrooms; all of the radiators now have covers in place to protect people living at the service from burns and scalds and automatic self closing mechanisms are on the doors which would activate in the event of fire to keep people safe. The home was clean and tidy in all the areas that we saw, and we found that bedrooms and lounges are Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 21 personalised. Bedrooms have lockable drawers for people living at the service to keep their belongings safe. We found that although there is an alarm call system in place as there are no extension cords people who have restricted mobility or arm movement cannot use the system to call for assistance. There is no call alarm system in the lounge and one person told us that if they need assistance they shout to the staff. People living at the service told us they like their rooms they said, “I have a lovely bedroom,” and “ my bedroom is small but clean”. A person visiting the service said, “(my relative) has a lovely bedroom, very clean”. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The recruitment of staff is not safe and places people living at the service at risk from those who may not be suitable to work with them. There are not enough staff on duty to meet their holistic needs. EVIDENCE: We looked at the staff rota; this was a generic rather than a specific rota for the week. It seems to indicate that morning shifts are staffed by three staff and afternoons by two staff, but there is no evidence to prove that these hours are actually worked week on week. The hours of the acting manager are not recorded on the rota as required by Law. The senior carer told us that these hours are sufficient, but other care staff we spoke with did not share this view. Staff we spoke to told us, “It’s too much for two people on a shift,”and said, “we have asked for more staff in the afternoon.” A relative told us, “they are always short of staff.” One relative told us, “ My wife is kept waiting if she wants anything. She needs to shout for staff and she is often wearing other peoples clothes.” We could not find the staff training records and we are therefore not able to assess the standards on National Vocational Qualifications, nor can we find any Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 23 evidence to prove that the outstanding requirement on providing staff training has been met. One person told us that she has done Dementia care training, Moving and Handling training, fire training, there was no proof of these courses at the service. The staff we spoke with told us that the Infection Control Nurse had been in and talked to them about the person who currently has a transmissible infection. There were no records to support this. We looked at five staff files and found that none of these were adequate. References are missing and they are not necessarily from previous employers, employment histories have unexplained gaps and there is no evidence on one file that Criminal Records Bureau disclosures have been discussed with the person and their continued employment risk assessed. The staff we spoke with said that they had completed their application forms at their interview. As this is an unmet requirement, (which the acting manager told us in her improvement plan had been met) we served a Code B notice under The Police and Criminal Evidence Act 1984 and seized staff files. We will look at this evidence and decide whether we need to take any further enforcement action to secure compliance and the safety of people living at the home. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home is not good enough to ensure that the service being delivered is safe, appropriate and in the best interests of people living there. The providers are not demonstrating their fitness to be registered by fulfilling their responsibilities and they are failing to make sure the service is being properly conducted and managed. EVIDENCE: An acting manager who is registered at another home is running the service. The acting manager has not applied to become registered for this service. The acting manager gave us assurances in the improvement plan for the service that all of the issues raised by the previous inspection had been addressed. We have found that this is not the case and we have very serious Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 25 concerns about how the service is being run. (See OP3, OP7, OP8, OP9, O10, OP12, OP15, OP16, OP18, OP22, OP27, OP29, OP30, OP33, OP35, OP38). The number and nature of requirements we have made following this visit indicates that the service is not being managed in a way which is safe and enhances the quality of life of the people who live there. In addition we have learned at this inspection about a significant number of incidents which the acting manager has failed to notify us about, as she is legally required to do. (See OP3, OP8, OP16.) In addition we have extremely serious concerns about the fitness of the registered provider. We have no evidence that he has been visiting the service every month and producing a report as to how the service is being run and conducted. As can be seen most of the records held at the service are inadequate but it is clear that these issues have not been recognised and attended to by the provider. He was notified of the serious issues raised at our inspection by the Senior Carer but declined to come to the service. The staff we spoke with told us that they are not always paid correctly and have to ask for their wages on occasions. One staff member told us they have sent a letter of complaint to the provider regarding their wages but has not had a response as yet. We could not locate any evidence that Quality Assurance audits take place at the service and the statement of purpose written by the acting manager shows a very poor understanding of Quality Assurance and auditing. This is an outstanding requirement. The people living at the service and the relatives we spoke with seem unaware of Quality Assurance auditing. During the course of the inspection we found a number of discrepancies in the records held about the finances of people living at the service. We seized records, made a safeguarding referral and contacted the Police to report the matter. This is part of an ongoing Police investigation; we are unable to comment further at this stage. We could not find any evidence that people who work at the service are being supervised. This is extremely concerning given that they do not appear to be receiving training, and there is no evidence that poor practice is being challenged even when it has been reported (see OP16 and 18.) This shows poor management of the service and its staff resulting in poor outcomes for people living at the service. We were very concerned about the way staff moved and handled the people living at the service; we witnessed people being lifted manually rather than using equipment. This is very poor practice. Staff we spoke with told us they knew they should use the hoist but said, “we don’t always use it.” They also told us that they have not had training in moving and handling even though they both use the hoist. We issued an immediate requirement on this matter. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 26 We also noted various concerns about fire safety and we will be making a referral to the Fire Safety Officer. Their requirements and recommendations must be complied with. The Portable Appliance Testing was noted to be overdue. A relative told us that a person living at the service had fallen and broken their shoulder but when we checked the records, there was no evidence that this has been recorded in the accident book. Nor was the incident notified to us. Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 1 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 3 X 2 3 3 3 3 STAFFING Standard No Score 27 1 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 1 X 1 Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, Sch 1 Requirement There must be an up to date statement of purpose which covers the areas specified in Schedule 1, to provide people wanting to live at the service with up to date information on which to base their decisions about living at the home. This must include a copy of the summary of the latest inspection report. This requirement is outstanding – timescale of 31/1/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. Section 24 People must not be admitted to Care the home whose needs are not Standards reflected by the registration Act 2000 categories and the content of your statement of purpose in order to ensure their assessed needs can be met. 14(1) People must not be admitted to the home unless they have been DS0000070838.V370504.R01.S.doc Timescale for action 31/10/08 2. OP3 15/10/08 3. OP3 15/10/08 Page 29 Chestnut Park Care Home Version 5.2 4. OP7 15 5. OP7 14(2) assessed by a suitably qualified and competent person and you have confirmed in writing that their needs can be met at the service. Information from any assessment must be passed on to the staff without delay so that they can meet people’s needs and protect their health and wellbeing effectively. Every person who lives at the service must have a plan of care which shows how their needs are to be met. Staff must follow these plans to make sure people’s needs are fully and safely met. Care plans must be kept under review so that they reflect the current needs of the people living at the service and so the staff give them the support they need. This requirement is outstanding – timescale of 11/1/08 not met. 31/10/08 31/10/08 6. OP8 13(3) 7. OP8 13(4)(c) The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. Staff must follow the correct 15/10/08 infection control procedures (for each specific illness) at all times to prevent the risk of cross infection between staff and other people living at the service. Staff must follow the guidance in 15/10/08 care plans or risk assessments to prevent the development of pressure sores and must refer any signs that sores are developing to the District Nurse without delay to maintain the health of people living at the service. DS0000070838.V370504.R01.S.doc Version 5.2 Page 30 Chestnut Park Care Home 8. OP8 13(4)(c) All of the people who live at the service must have nutritional screening on admission and those identified as being at risk must have food intake and weight records to ensure their health and wellbeing. 31/10/08 9. OP9 13(2) 10. OP9 13(2) This requirement was set at the previous inspection and the timescale set has not yet expired. Staff must receive training on 31/10/08 how to administer medication safely and there must be appropriate supervision of staff to make sure they understand the importance of people receiving their medication as their Doctor prescribed. 21/08/08 People must be given their medication as prescribed by their Doctor. If medication is omitted for any reason staff must indicate why this is the case on the Medication Administration Record sheet so the health and wellbeing of people living at the service can be properly monitored and reported on. This is an immediate requirement 1. There must be a clear 21/08/08 record of any medication which is to be returned to the pharmacist for disposal to avoid the misappropriation of medicines. 2. Medication must be returned without undue delay to avoid the misappropriation of medicines. 3. The stocks of medication held at the service must be controlled to make sure DS0000070838.V370504.R01.S.doc Version 5.2 Page 31 11. OP9 13(2) Chestnut Park Care Home these are not unnecessarily high to avoid the misappropriation of medicines. 4. The record of medication received should include medication already in stock to enable proper auditing and to avoid the misappropriation of medicines. This is an immediate requirement 18(2) The performance of staff must be closely supervised to ensure that they treat the people living at the service with consideration, respect for their dignity, privacy and upholding their right to confidentiality. 16(2)(m & People who live at the service n) must be consulted about their social interests and these must be provided for to make sure their social and recreational needs are met. 22 A copy of the complaints procedure must be given to every person living at the service, or be displayed so that people are clear about how to raise concerns and the process that will be followed in response to complaints. 22 All complaints, their investigation and outcome must be recorded. Complainants must be responded to so they can be assured that their concerns have been heard and acted upon. 13(6) All staff must have training on safeguarding adults to ensure they understand what kind of behaviour is abusive and they must put their knowledge into practice if allegations are made by following local safeguarding DS0000070838.V370504.R01.S.doc 12. OP10 15/10/08 13. OP12 31/10/08 14. OP16 15/10/08 15. OP16 15/10/08 16. OP18 31/10/08 Chestnut Park Care Home Version 5.2 Page 32 procedures to protect people from harm and abuse. This requirement is outstanding – timescale of 3/3/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. There must be a robust policy 15/10/08 and procedure in place for responding to and reporting suspicion or evidence of abuse or neglect. This will ensure service users are safeguarded from all abuse. This requirement is outstanding – timescale of 3/3/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. All allegations of abuse (including neglect) must be reported in line with local safeguarding procedures to the Local Authority and the Commission for Social Care Inspection to make sure people are safeguarded properly. Extensions to alarm calls in bedrooms and in the lounge must be provided to make sure the people living at the service could summon help in an emergency. The staffing levels at the service must be reviewed and you must be able to demonstrate to us that there are sufficient staff on duty to ensure that people DS0000070838.V370504.R01.S.doc 17. OP18 13(6) 18. OP18 13(6) 15/10/08 19. OP22 13(4)(c) 31/10/08 20. OP27 18(1)(a) 15/10/08 Chestnut Park Care Home Version 5.2 Page 33 21. OP27 17(2) Sch 4(7) 22. OP29 19, Sch 2 accommodated are safe, receive the care they need and have their holistic needs met. There must be an accurate record of the hours worked by all staff and in what capacity to make sure that these are sufficient to meet people’s needs. Staff must not start working at the home until all the necessary recruitment checks have been carried out including a Protection of Vulnerable Adults First check and a satisfactory Criminal Records Bureau disclosure. These checks have to be applied for and obtained before staff commence employment to ensure that people living at the service are protected from those who may harm or abuse them. This requirement is outstanding – timescale of 21/12/07 not met. Statutory Enforcement Notice issued. Staff files must contain the information and documentation specified in Schedule 2 to ensure that people who live at the service are protected from those who may not be suitable to work with vulnerable people. This requirement is outstanding – timescale of 29/2/08 not met. Statutory Enforcement Notice issued. The staff must be trained and competent and there must be evidence of all training undertaken by staff at the service, to ensure that staff can DS0000070838.V370504.R01.S.doc 15/10/08 10/11/08 23. OP29 19, Sch 2 10/11/08 24. OP30 18(1)(c) (i) 31/10/08 Chestnut Park Care Home Version 5.2 Page 34 understand and fully meet the needs of the people living at the home. This requirement is outstanding – timescale of 30/3/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. The management of the service 31/10/08 must improve to ensure that the issues raised by this inspection are addressed and that the home runs in the best interests of the people who live there. 31/10/08 A suitably competent and qualified manager must be appointed and must submit an application to become registered with the Commission for Social Care Inspection to ensure the service is being run and managed safely and effectively. This requirement is outstanding – timescale of 31/1/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. All incidents specified in this 15/10/08 Regulation must be notified to us at the commission to enable us to risk assess and monitor the service being provided to people who live at the service. A report must be produced every 31/10/08 month and sent to us at the commission, which shows how the home is being conducted to make sure the people who live at DS0000070838.V370504.R01.S.doc Version 5.2 Page 35 25. OP31 10(1) 26. OP31 9, Section 11 Care Standards Act 2000 27. *RQN 37 28. *RQN 26 Chestnut Park Care Home 29. *RQN 7(1) 30. OP33 24 the service are safe and well cared for. The providers of this service 15/10/08 must take responsibility for making sure that the home is being run and managed safely and effectively and in the best interests of the people living there in order to prove their continued fitness to remain registered. There must be an effective 31/10/08 quality assurance and quality monitoring system in place to ensure the home is being run in the best interests of people living at the service. This requirement is outstanding – timescale of 29/2/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. There must be a safe and robust system in place for handling money held on behalf of people living at the service to ensure their financial interests are protected and they cannot be abused. There must be evidence that staff are closely supervised and monitored and that any issues raised about their performance are recorded to ensure that people living at the service are supported by a caring and effective staff team. Portable Appliance Testing must be undertaken without delay to ensure the safety of people living at the service and staff. Any requirements or recommendations the Fire Safety DS0000070838.V370504.R01.S.doc 31. OP35 13(6) 15/10/08 32. OP36 18(2) 31/10/08 33. OP38 23(2)(c) 15/10/08 34. OP38 23(4) 31/10/08 Page 36 Chestnut Park Care Home Version 5.2 35. OP38 17(1)(a), Schedule 3(3)(j) Officer makes must be adhered to within the timescales they set to ensure the people living at the service are safe in the event of a fire. There must be a record of every accident to make sure that there is an accurate record of falls and injuries sustained so we can be assured that people are safe and receiving the care and treatment they need. 15/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations A signed copy of each person’s Terms and Conditions of residence must be held and be available for inspection so we know they have a clear understanding of the service they can expect at the home. The medication policy must follow the guidelines of the Royal Pharmaceutical Society to ensure staff are aware of safe and best practice and follow this. People who are nutritionally at risk should be encouraged to eat when they refuse to try and prevent further weight loss and the deterioration of their health. Any refusal to eat or drink should be recorded so the health of people living at the service can be monitored and reported on. The results of service user surveys should be published and made available to people living at the service and the Commission for Social Care Inspection. Outstanding 2. 3. OP9 OP15 4. OP33 Chestnut Park Care Home DS0000070838.V370504.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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